Hypertensive Drugs Flashcards
Thiazide diuretic, that inhibits Na/Cl trransporter in distal convoluted tubule. First line for hypertension
Hydrochlorothiazide - SIMD: Metolazone, Indapamide; decrease Bp by 10-15mmHg
Hypertensive patient with no comorbidities, what would be the bp goal of this patient?
Co comorbidities <130/80
Feature of a Thiazide toxicity
HYPER GLUC - hyperGlycemia, hyperLipidemia, hyperUricemia and hyperCalcemia
Loop diuretics that inhibits Na/K/2Cl transporter in thick ascending limb of Henle. Powerful diuresis and increase Ca excretion
Furosemide - SE: hypokalemic metabolic acidosis
MOA of Clonidine and Methyldopa as CNS sympathetic outflow blockers
Activates a2 adrenergic receptors, decrease central sympathetic outflow
SIMD of Hexamethonium an obsolete hypertensive drug
Trimethaphan - ganglionic blocker
Nerve terminal blocker that irreversibly blocks the vesicular monoamine transporter (VMAT) used as an obsolete hypertensive agent
Reserpine - SIMD: Guanethidine; causes suicidal ideation
Vasodilator, used for hypertension, heart failure and pre-eclampsia. May caused drug-induced lupus
Hydralazine - alters intracellular Ca metabolism thus relaxes arteriolar smooth muscle
Medications that may cause drug-induced lupus
HIPP - Hydralazine, Isoniazid, Procainamide, Penicillamine
Vasodilator, specific for arterioles decreasing afterload. Opens K+ channels in vascular smooth muscle, causing hyperpolarization thus relaxation and vasodilatation.
Minoxidil
Notable side effect of Minoxidil
Hypertrichosis - it stimulates hair follicle at telogen phase to differentiate into growth follicles, anagen phase
Non-dihydropyridine calcium channel blocker, used for angina, migraine and hypertension, SE: gingival hyperplasia, heart failure
Verapamil / Diltiazem - block voltage-gated L-Type calcium channels
Dihydropyridine, calcium channel blocker which has more effect on vascular than cardiac used for angina and hypertension
Nifedipine - SIMD: Amlodipine, Nicardipine, Felodipine
Parenteral vasodilator, for hypertensive emergency, acute heart failure, cardiogenic shock
Nitroprusside - SE: cyanide toxicity
Dopamine agonist used as parenteral vaodilator for hypertensive emergency by causing arteriolar vasodilation of both afferent/efferent arterioles.
Fenoldopam
True/False: ACE-Is/ARBs reduce aldosterone levels and cause potassium retention hence results to hyperkalemia
True
ACE inhibitor for hypertension, heart failure, post-MI, diabetic nephropathy. Increases survival in heart failure, delays progression of diabetic nephropathy
Captopril - SIMD: Enalapril, Quinapril etc.
Management for malignant hypertension:
Vasodilators: nitroprusside, fenoldopam or diazoxide combined with diuretics (furosemide) and beta-blockers to lower bp to 140-160/90-110
Antidote for cyanide poisoning
Inhaled amyl nitrite + IV sodium nitrite + IV sodium thiosulfate
ARB - used fir hypertension, heart failure and diabetic nephropathy. It blocks Angiotensin (AT1 receptor) in vascular smooth muscle. Dec aldosterone
Losartan - SIMD: Candesartan, Telmisartan, Irbesartan
Angina can be corrected in two ways
A. Increasing oxygen delivery
B. Reducing oxygen requirement
Angina of effort or classic angina, associated with atheromatous plaques that partially occlude 1 or more coronary arteries
Atherosclerotic Angina - 90% of angina cases
Creasendo angina, immediate precursor of myocardial infarction
Unstable angina
disease due to occupational exposure to nitrates alternating development of tolerance
Monday disease
Ultrashort- acting nitrate, used in cyanide poisoning with methemoglobinemia as one of the side effects.
Amyl nitrite
Short-acting nitrate, used for angina and acute coronary syndrome which may develop dangerous hypotension with PDE inhibitors
Nitroglycerin - releases nitric oxide, increases cGMP and relaxes smooth muscles
Why do patients taking nitrates usually experience throbbing headaches?
Due to meningeal artery vasodilation
Dihydropyridine calcium channel blocker used for angina and hypertension ( vascular>cardiac)
Nifedipine - SIMD: Amlodipine, Nicardipine
Drugs that causes gingival hyperplasia?
Nifedipine, Cyclosporine, Phenytoin, Verapamil
Current evidence: acute heart failure should be treated with ____ diuretics.
Loop diuretics
Type of heart failure that present with orthopnea, PND, pulmonary congestion
Left heart failure
Type of heart failure that presents with hepatomegaly, edema, engorged neck veins
Right heart failure
Cardiac glycoside used for heart failure and nodal arrhythmias. It has a narrow therapeutic index
Digoxin - inhibits Na/K ATPase, increasing intracellular Ca, increaing cardia contractility
Drugs with narrow therapeutic index
Warfarin, aminoglycosides, lithium, amphotericin B, carbamazepine, phenobarbital, phenytoin, vancomycin, theophylline, digoxin
First line therapy for both systolic and diastolic failure
Diuretics
Have a significant long term benefits and can reduce mortality in chronic failure
Spironolactone and Eplerenone
It is the first line drugs for chronic heart failure
Angiotensin antagonist - ARBs have the same benefits with ACE inhibitors
Vasodilators that has been shown to reduce mortality in african americans
Hydralazine and Isosorbide dinitrates
Portion of ETC affected by cyanide
Complex IV (cytochrome oxidase)
Refers ti accelerated form of severe hypertension associated with rising blood pressure and rapidly progressing end-organ damage
Malignant hypertension
Rest angina, variant angina or Prinzmetal’s angina, involves reversible spasm of coronaries, usually at site of plaques
Vasospastic angina - 10% of cases
Renin antagonist that inhibits conversion of angiotensinon to angiotensin I. For hypertension
Aliskiren
